Key result
WCDs show high compliance and deliver appropriate shocks to ~1.6% of patients with transient SCD risk.
Why the study?
Contemporary real-world data were needed on wearable cardioverter-defibrillator use, focusing on effectiveness, safety, compliance, and acceptability.
Is the wearable cardioverter-defibrillator (WCD) effective, safe, and well-tolerated in patients with a transient risk of sudden cardiac death?
Cohort (n=1,157)
Yes
Is the wearable cardioverter-defibrillator (WCD) effective, safe, and well-tolerated in patients with a transient risk of sudden cardiac death?
The wearable cardioverter-defibrillator is effective, safe, and associated with high compliance in patients with a transient high risk of sudden cardiac death when supported by patient education and remote monitoring.
Answers are grounded in this paper and cite their sources.
Supports WCD tolerability in transient SCD risk; hypothesis-generating and requires RCTs before practice change.
AIMS: We aimed to provide contemporary real-world data on wearable cardioverter-defibrillator (WCD) use, not only in terms of effectiveness and safety but also compliance and acceptability. METHODS AND RESULTS: Across 88 French centres, the WEARIT-France study enrolled retrospectively patients who used the WCD between May 2014 and December 2016, and prospectively all patients equipped for WCD therapy between January 2017 and March 2018. All patients received systematic education session through a standardized programme across France at the time of initiation of WCD therapy and were systematically enrolled in the LifeVest Network remote services. Overall, 1157 patients were included (mean age 60 ± 12 years, 16% women; 46% prospectively): 82.1% with ischaemic cardiomyopathy, 10.3% after implantable cardioverter-defibrillator explant, and 7.6% before heart transplantation. Median WCD usage period was 62 (37-97) days. Median daily wear time of WCD was 23.4 (22.2-23.8) h. In multivariate analysis, younger age was associated with lower compliance [adjusted odds ratio (OR) 0.97, 95% confidence interval (CI) 0.95-0.99, P < 0.01]. A total of 18 participants (1.6%) received at least one appropriate shock, giving an incidence of appropriate therapy of 7.2 per 100 patient-years. Patient-response button allowed the shock to be aborted in 35.7% of well-tolerated sustained ventricular arrhythmias and in 95.4% of inappropriate ventricular arrhythmia detection, finally resulting in an inappropriate therapy in eight patients (0.7%). CONCLUSION: Our real-life findings reinforce previous studies on the efficacy and safety of the WCD in the setting of transient high-risk group in selected patients. Moreover, they emphasize the fact that when prescribed appropriately, in concert with adequate patient education and dedicated follow-up using specific remote monitoring system, compliance with WCD is high and the device well-tolerated by the patient.
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Garcia et al. (2020) conducted a cohort in transient risk of sudden cardiac death (n=1,157). Wearable cardioverter-defibrillator (WCD) was evaluated on Appropriate shock. Wearable cardioverter-defibrillator use in patients with transient risk of sudden cardiac death demonstrated high compliance and delivered appropriate shocks in 1.6% of patients.
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